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Translating Mechanisms Into Practice for Cushing Syndrome

  • Authors: Maria Fleseriu, MD, FACE
  • CME / ABIM MOC / CE Released: 7/31/2023
  • Valid for credit through: 7/31/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for endocrinologists, primary care physicians, nurses, nurse practitioners, physician assistants, and other clinicians who treat patients with CS.

The goal of the activity is improvement in the learner's ability to identify the role of new treatments and interprofessional team strategies to manage CS.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Role of cortisol in CS and common clinical presentations
    • Management of CS syndrome with new treatments


Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Maria Fleseriu, MD, FACE

    Professor of Medicine and Neurological Surgery
    Director of the Pituitary Center
    Oregon Health & Science University
    Portland, Oregon


    Maria Fleseriu, MD, FACE, has the following relevant financial relationships:
    Consultant or advisor for: Recordati; Sparrow; Xeris
    Research funding from: Recordati; Sparrow; Xeris


  • Jennifer Hakkarainen, PA-C

    Medical Education Director, Medscape, LLC


    Jennifer Hakkarainen, PA-C, has no relevant financial relationships.

  • Jason Luis Quiñones, PhD

    Associate Medical Writer, Medscape, LLC


    Jason Luis Quiñones, PhD, has no relevant financial relationships.

Compliance Reviewer/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements


Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per five-year cycle. Any additional credits are eligible as non-certified credits. College of Family Physicians of Canada (CFPC) members must log into Mainpro+® to claim this activity.

    Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

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    For Nurses

  • Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


Translating Mechanisms Into Practice for Cushing Syndrome

Authors: Maria Fleseriu, MD, FACEFaculty and Disclosures

CME / ABIM MOC / CE Released: 7/31/2023

Valid for credit through: 7/31/2024, 11:59 PM EST



  1. Reincke M, et al. Cushing syndrome: a review. J Am Med Assoc. 2023;330:170-181.
  2. Barbot M, et al. Cushing's syndrome: overview of clinical presentation, diagnostic tools and complications. Best Pract Res Clin Endocrinol Metab. 2020;34:101380.
  3. Varlamov EV, et al. Management of endocrine disease: cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing's syndrome: a practical approach. Eur J Endocrinol. 2021;184:R207-R224.
  4. Limumpornpetch P, et al. The effect of endogenous Cushing syndrome on all-cause and cause-specific mortality. J Clin Endocrinol Metab. 2022;107:2377-2388.
  5. Scoffings K, et al. Recognizing and diagnosing Cushing's syndrome in primary care: challenging but not impossible. Br J Gen Pract. 2022;72:399-401.
  6. Akirov A, et al. Cushing's syndrome in women: age-related differences in etiology and clinical picture. Pituitary. 2023;26:144-151.
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  9. Galm BP, et al. Accuracy of laboratory tests for the diagnosis of Cushing syndrome. J Clin Endocrinol Metab. 2020;105:2081-2094.
  10. Petersenn S. Biochemical diagnosis of Cushing's disease: screening and confirmatory testing. Best Pract Res Clin Endocrinol Metab. 2021;35:101519.
  11. Petersenn, S. Overnight 1 mg dexamethasone suppression test and 24 h urine free cortisol--accuracy and pitfalls when screening for Cushing's syndrome. Pituitary. 2022;25:693-697.
  12. Hinojosa-Amaya JM, et al. Hypercortisolemia recurrence in Cushing's disease; a diagnostic challenge. Front Endocrinol (Lausanne). 2019;10:740.
  13. Amlashi FG, et al. Accuracy of late-night salivary cortisol in evaluating postoperative remission and recurrence in Cushing's disease. J Clin Endocrinol Metab. 2015;100:3770-3777.
  14. Castinetti F, et al. Is desmopressin useful in the evaluation of Cushing syndrome? J Clin Endocrinol Metab. 2022;107:e4295-e4301.
  15. Moro M, et al. The desmopressin test in the differential diagnosis between Cushing's disease and pseudo-Cushing states. J Clin Endocrinol Metab. 2000;85:3569-3574.
  16. Mallari RJ, et al. Diagnostic pitfalls in Cushing disease: surgical remission rates, test thresholds, and lessons learned in 105 patients. J Clin Endocrinol Metab. 2022;107:205-218.
  17. Couselo M, et al. Pituitary tumor centers of excellence for Cushing's disease. Pituitary. 2022;25:772-775.
  18. Varlamov EV, et al. Updates in adrenal steroidogenesis inhibitors for Cushing's syndrome - a practical guide. Best Pract Res Clin Endocrinol Metab. 2021;35:101490.
  19. Fleseriu M, et al. Efficacy and safety of levoketoconazole in the treatment of endogenous Cushing's syndrome (SONICS): a phase 3, multicenter, open-label, single-arm trial. Lancet Diabetes Endocrinol. 2019;7:855-865.
  20. Pivonello R, et al. Levoketoconazole in the treatment of patients with endogenous Cushing's syndrome: a double-blind, placebo-controlled, randomized withdrawal study (LOGICS). Pituitary. 2022;25:911-926.
  21. Pivonello R, et al. Efficacy and safety of osilodrostat in patients with Cushing's disease (LINC 3): a multicentre phase III study with a double-blind, randomised withdrawal phase. Lancet Diabetes Endocrinol. 2020;8:748-761.
  22. Gadelha M, et al. Randomized trial of osilodrostat for the treatment of Cushing disease. J Clin Endocrinol Metab. 2022;107:e2882-e2895.
  23. Fleseriu M, et al. Levoketoconazole treatment in endogenous Cushing's syndrome: extended evaluation of clinical, biochemical, and radiologic outcomes. Eur J Endocrinol. 2022;187:859-871.
  24. Fleseriu M, et al. Long-term outcomes of osilodrostat in Cushing's disease: LINC 3 study extension. Eur J Endocrinol. 2022;187:531-541.
  25. Fleseriu M, et al. Treatment of Cushing's syndrome with osilodrostat: practical applications of recent studies with case examples. Pituitary. 2022;25:795-809.
  26. Webb SM, et al. Quality of life impairment after a diagnosis of Cushing's syndrome. Pituitary. 2022;25:768-771.
  27. Acree R, et al. Patient and provider perspectives on postsurgical recovery of Cushing syndrome. J Endocr Soc. 2021;5:1-14.
  28. He X, et al. Glucocorticoid withdrawal syndrome following treatment of endogenous Cushing syndrome. Pituitary. 2022;25:393-403.
  29. Varlamov EV, et al. Perioperative management of a patient with Cushing disease. J Endocr Soc. 2022;6:1-13.
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